复发高级别矢状窦旁脑膜瘤的显微外科手术治疗

Microsurgery for recurrent high grade parasagittal meningiomas

目的探讨显微外科治疗复发高级别矢状窦旁脑膜瘤的临床疗效,并进一步总结此类肿瘤的治疗经验。方法回顾性分析8例显微外科手术切除的复发高级别矢状窦旁脑膜瘤(WHOⅡ和Ⅲ级)病人的临床资料。6例肿瘤侵犯矢状窦腔和矢状窦壁的病人中,5例矢状窦未完全闭塞;余2例仅侵犯矢状窦壁和大脑镰。结果肿瘤切除程度:侵犯矢状窦腔和矢状窦壁的6例,其中SimpsonⅡ级切除4例,Ⅲ级切除2例;侵犯矢状窦壁和大脑镰的2例,其中SimpsonⅠ级切除1例,Ⅱ级切除1例。术后病理:不典型脑膜瘤4例(WHOⅡ级),脊索样脑膜瘤1例(WHOⅡ级),横纹肌样脑膜瘤1例(WHOⅢ级),间变型脑膜瘤2例(WHOⅢ级)。1例间变型脑膜瘤术后2个月死于脑脊液感染,余7例行常规放射治疗。随访7例,时间4～48个月,复发1例,偏瘫2例,余4例恢复良好。结论显微手术切除复发高级别矢状窦旁脑膜瘤可取得良好疗效,术前需做好周密的手术计划,术中应用神经电生理监测技术保护好与复发肿瘤明显黏连的引流静脉和脑组织,处理好肿瘤与上矢状窦的关系。

Objective To investigate the clinical effect of microsurgery for recurrent high grade parasagittal meningiomas,and to summarize the treatment experience.Methods Clinical data of 8 patients with recurrent high grade parasagittal meningiomas(WHO gradesⅡandⅢ)were analyzed retrospectively,who underwent microsurgical resection.The sagittal sinus cavity and sagittal sinus wall were invaded in 6 patients,of whom 5 patients had imcompleted occlusion of sagittal sinus,and sagittal sinus wall and cerebral falx were invaded in 2.Results In 6 patients with tumor invading the sagittal sinus cavity and sagittal sinus wall,Simpson gradeⅡresection were achieved in 4 and Simpson gradeⅢin 2.In 2 patients with tumor invading the sagittal sinus wall and cerebral falx,Simpson gradeⅠresection was performed in 1 and Simpson gradeⅡin 1.Postoperative pathology results were as follows:atypical meningioma in 4 patients(WHO gradeⅡ),chordoid meningioma in 1(WHO gradeⅡ),rhabdomyoid meningioma in 1(WHO gradeⅢ)and anaplastic meningioma in 2(WHO gradeⅢ).One patient with anaplastic meningioma died of cerebrospinal fluid infection 2 months after surgery.The remaining 7 patients received routine radiotherapy.Seven patients were followed up for 4 to 48 months,tumor relapse occurred in 1,hemiplegia in 2 and recovery in the remaining 4.Conclusions Microsurgical excision of recurrent high-grade parasagittal sinus meningiomas could achieve good therapeutic effect.The surgery planning needs to be well made before surgery and neuroelectrophysiological monitoring technique is used to protect the drainage veins and brain tissues which have obvious adhesion with recurrent tumors.The relationship between tumor and superior sagittal sinus should be properly dealed with.